A study of 230 of bipolar patients who were admitted to a Rhode Island psychiatric hospital in 2010 shows that 36 percent were receiving four or more psychotropic medications from their community providers.

The rate was significantly higher for women, according to findings published in the journal Psychiatry Research.

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Including prescriptions for other conditions, the average patient came to the hospital taking six different drugs. This medication burden, known as complex polypharmacy, results in high overall cost to patients and the healthcare system.

Yet for many patients, these combinations of drugs have not proven sufficiently effective, says lead author Lauren Weinstock, assistant professor (research) of psychiatry and human behavior at Brown University, who is on staff at Butler Hospital where the patients were admitted.

“The high rate of complex polypharmacy reflects the enormous challenge of symptom management that we currently face for bipolar disorder,” she says. “Without many treatment alternatives, this is where we are as a field. It is important for us to advance science and treatment of bipolar disorder so that this medication burden can be minimized for our patients.”

Weinstock and colleagues were motivated to quantify the pharmacological burden for those with biploar disorder after witnessing it anecdotally among patients.

Too many prescriptions?

The researchers compiled data from patients’ hospital admission records in the calendar year 2010. The only inclusion criteria were that patients had to be 18 years or older and have a diagnosis of bipolar I disorder at hospital admission and discharge.

“The data aren’t confounded by someone’s active participation in a research study,” Weinstock says. “We wanted to measure what was happening in routine community practice.”

What they found is that when they came to the hospital, patients were taking an average of 3.3 psychotropic drugs and an average of 5.9 drugs overall. Nearly one in five patients were not on any psychotropic drugs, but more than half were taking three or more and more than a third were taking four or more, meeting the definition of “complex polypharmacy.”

The complex polypharmacy rate of 36 percent is higher than in a few previous studies that looked at bipolar patients, Weinstock says, because those studies did not always include all psychotropic medications, such as the commonly prescribed antianxiety medications.

Because no clinical trial of bipolar medications has ever tested more than two drugs in combination, prescribing three or four exceeds practices supported by the field, Weinstock says.

No prior studies have looked at the total medication burden, rather than just that of pyschotropics. It’s important to do so, Weinstock says, because cardiometabolic diseases, in particular, are often concurrent with bipolar disorder. Among the 230 patients in the study, for example, about half had such medical problems.

More meds for women

Of participants in the study, women were 58 percent of the total patients, but 68 percent of those with complex polypharmacy. Women are more likely to be on an antidepressant, anti-anxiety medication, and on stimulants, all of which remain somewhat controversial in bipolar disorder treatment.

The proportion of women taking an antidepressant (43 percent) was nearly twice that of men (23 percent). The significance of the gender disparities in the study endured even after statistically controlling for depressive symptoms in their diagnosis.

“Women weren’t prescribed more medications just because they were more likely to be depressed,” Weinstock says. “This finding raises the question of what other factors may influence higher rates of polypharmacy among female patients, such as patient or provider characteristics.”

The study does not provide information that could reveal why that is. Still, combined with other studies and epidemiological data, the study points to a trend that needs improving.